Provider Demographics
NPI:1891851291
Name:SMITH, TIMOTHY LEE (MS, LPC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5158 STAGE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3116
Mailing Address - Country:US
Mailing Address - Phone:901-488-0073
Mailing Address - Fax:901-377-9866
Practice Address - Street 1:5158 STAGE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-3116
Practice Address - Country:US
Practice Address - Phone:901-488-0073
Practice Address - Fax:901-377-9866
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000000554101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health